Extended Criteria Donor Kidney Transplantation: Comparative Outcome Analysis Between Single versus Double Kidney Transplantation at 5 Years

Abstract Introduction Dual kidney transplantation (DKT), using extended criteria donor (ECD) grafts not suitable for single kidney transplantation (SKT), has been suggested to expand the kidney donor pool. Herein, we reviewed the long-term outcomes of DKT to assess its results versus a control group...

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Bibliographic Details
Published in:Transplantation proceedings 2010-05, Vol.42 (4), p.1104-1107
Main Authors: Lucarelli, G, Bettocchi, C, Battaglia, M, Impedovo, S.V, Vavallo, A, Grandaliano, G, Castellano, G, Schena, F.P, Selvaggi, F.P, Ditonno, P
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Body Mass Index
Delayed Graft Function
Female
Follow-Up Studies
Functional Laterality
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Graft Rejection - epidemiology
Graft Survival - physiology
Humans
Kidney Transplantation - methods
Kidney Transplantation - mortality
Kidney Transplantation - pathology
Kidney Transplantation - physiology
Kidneys
Male
Malformations of the urinary system
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Patient Selection
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Survival Rate
Time Factors
Tissue Donors
Tissue, organ and graft immunology
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Summary:Abstract Introduction Dual kidney transplantation (DKT), using extended criteria donor (ECD) grafts not suitable for single kidney transplantation (SKT), has been suggested to expand the kidney donor pool. Herein, we reviewed the long-term outcomes of DKT to assess its results versus a control group of 179 ECD SKTs. The allocation policy was based on a Remuzzi score obtained from a pretransplant biopsy. Materials and methods We analyzed SKT in 179 (31.8%) and DKT in 41 (7.3%) of 563 cadaveric transplants from 2000 to 2008. Patients with DKT versus SKT showed mean recipient ages of 54 versus 51 years. We performed 17 ipsilateral and 24 bilateral DKT. The mean score was 2.78 for SKT and 4.3/4.6 for DKT. Results Delayed graft function requiring dialysis occurred in 23 (56.1%) DKT and 70 (39.1%) SKT recipients. Primary nonfunction was observed in 1 (2.4%) DKT and 7 (3.9%) SKT recipients respectively. One DKT patient underwent monolateral transplantectomy. In the DKT versus SKT group, patient survivals were 92% versus 95%, 89% versus 93%, and 89 versus 91% at 12, 36, and 60 months, respectively ( P = .3). Graft survivals were 100% versus 94%, 95% versus 90%, and 89% versus 78% at 12, 36, and 60 months, respectively ( P < .001). We observed a lower incidence of chronic allograft nephropathy ( P = .01) and a higher incidence of surgical adverse events ( P = .04) in DKT. Conclusions ECD graft survival using DKT provided better results compared with SKT, despite the use of organs from higher-risk donors. At 5 years follow-up, DKT was a safe strategy to face the organ shortage. To optimize the use of available kidneys, the criteria for DKT require further refinement and standardization. Preimplantation evaluation must maximize transplant success and protect recipients from receiving organs at increased risk of premature failure.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2010.03.059